The Buying Value Measure Selection Tool

Transcription

1 The Buying Value Measure Selection Tool Strategies for Selecting Measures and Developing Aligned Measure Sets Michael Bailit and Deepti Kanneganti January 4, 2017

2 Webinar Presenter: State Health and Value Strategies Dan Meuse Deputy Director 2

3 The Robert Wood Johnson Foundation s State Health and Value Strategies Program Supports state efforts to enhance the quality and value of health care by improving population health and reforming health care delivery Works directly with states including Medicaid agencies, governors offices, and more to promote peerto-peer learning Connects states with technical assistance experts to develop tools for new quality improvement and cost management initiatives Collaborates with other funders and stakeholders to produce issue briefs and host convenings, focusing on best practices for states 3

4 Webinar Presenters: Bailit Health Michael Bailit Deepti Kanneganti Dedicated to working to working with public agencies and private purchasers to improve health care system performance. 4

5 Logistics This webinar is being recorded. The recording and slides will be available following the webinar. Telephone lines will be open to allow for questions. Please mute your line. Please do not put your line on hold. Questions can be submitted electronically at any time. 5

6 Asking Questions Electronically Right click on the Chat button in the top right of the WebEx program. Type your question in the chat box. Select All Panelists and click Send. The Q&A function can also be used in a similar way. 6

7 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Learn About Vermont s Experience 6. Respond to Questions and Share Resources

8 The History of Buying Value The Buying Value Measure Selection Tool (BVMST) was developed as part of a suite of nine resources to assist state agencies, private purchasers and other stakeholders in creating aligned measure sets. The tool was first published in Since then, it has been used by a number of states, including: Connecticut Vermont Oregon Washington Rhode Island In 2016, with SHVS support, Bailit Health updated the tool to include current measure sets and add new functionality. 8

9 Once upon a time there were no measures In 1989 large employers were complaining that they had no data to assess the value generated by their health plans. In response, a group of health plans decided to work with a small group of large employers to identify standard measures that could be used to demonstrate value. The result of that effort HEDIS 1.0 was released in 1991 with a limited number of quality measures most of which were focused on prevention. 9

10 And now here we are today! 26 years later, we are awash in measures! The 2013 Buying Value study of measure sets in 25 states and three regional collaboratives found: 1,367 measures in use across 48 measure sets, of which 509 were distinct, nonduplicated measures Only 20% of the 509 measures were used in 2+ measure sets There were 650 NQF-endorsed measures as of

11 Why Focus on Measure Alignment? 1. Providers can t respond to the large number of measures they are being asked to improve. 2. The measure-related requirements on providers for coding claims and medical records is a significant contributor to primary care burnout. 3. Constant change in measure set composition only worsens these problems for providers. 11

12 The Current Landscape of Measure Alignment There are national initiatives designed to create alignment, but they have had limited effect so far. National Initiatives: CMS Core Quality Measure Set IOM s Core Metrics States have not waited for national alignment, and have facilitated their own measure alignment processes. Statewide Initiatives: Rhode Island: SIM Aligned Measure Sets Washington: Common Measure Set on Healthcare Quality and Cost 12

13 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Learn About Vermont s Experience 6. Respond to Questions and Share Resources

14 How to Create an Aligned Measure Set The RWJF-supported Buying Value Project developed a suite of tools in 2014, titled How to Build A Measure Set, to assist state agencies, private purchasers, and other stakeholders in creating aligned performance measure sets. The full suite of resources is available on the Buying Value website ( 14

15 How to Create an Aligned Measure Set (Cont.) 15

16 How to Create an Aligned Measure Set (Cont.) 16

17 How to Create an Aligned Measure Set (Cont.) 17

18 How to Create an Aligned Measure Set (Cont.) 18

19 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Learn About Vermont s Experience 6. Respond to Questions and Share Resources

20 2016 Buying Value Measure Selection Tool Updates 1. Refreshed all measure sets in the tool, including: a. Updating measures included in current federal, national, and state measure sets b. Adding new notable federal measure sets (e.g., Meritbased Incentive Payment System (MIPS) Measures) c. Removing measure sets that are no longer in use 2. Created a new function that allows users to search through 600+ measures by domain, condition, measure type, population, and data source 20

21 Measure Sets Included in the Tool Federal and National Measure Sets Included in the Tool (15) Catalyst for Payment Reform Employer- Purchaser Measure Set* CMMI Comprehensive Primary Care Plus (CPC+) # CMMI SIM Recommended Model Performance Metrics CMS Core Set of Children s Health Care Quality Measures for Medicaid and CHIP (Child Core Set) CMS Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid (Medicaid Adult Core Set) CMS Core Quality Measures Collaborative* CMS Health Home Measure Set CMS Hospital Value-Based Purchasing CMS Medicare Hospital Care CMS Medicare-Medicaid Plans (MMPs) Capitated Financial Alignment Model (Duals Demonstrations) CMS Medicare Part C & D Star Ratings Measures CMS Medicare Shared Savings Program (MSSP) ACO CMS Merit-based Incentive Payment System (MIPS)* CMS Physician Quality Reporting System (PQRS); CMS EP EHR Incentive Clinical Quality Measures (ecqms); and CMS Cross Cutting Measures (CCMs) Joint Commission Accountability Measures List *This measure set was added to the tool. # This measure set replaced an existing measure set. 21

22 Measure Sets Included in the Tool (Cont.) State Measure Sets Included in the Tool Medi-Cal P4P Measure Set* Oregon CCO Incentive Measures Oregon CCO State Performance Test Measures Rhode Island SIM Aligned Measure Set for ACOs* Vermont ACO Pilot Core Performance Measures for Payment and Reporting Washington State Common Measure Set for Health Care Quality and Cost *This measure set was added to the tool. 22

23 Buying Value Tool Search Function Domain Acute Illness Care Ambulatory Surgery Center Ambulatory Surgery Center and Hospital Chronic Illness Care Health/Drug Plan Health Information Technology Home Health Hospice Hospital Medication Management Overuse Population Health Post-Acute/Long- Term Care Prevention Not Applicable (NA) Other Condition Auditory Cancer Cardiovascular Dental Diabetes Emergency Care Gastrointestinal Genitourinary Infectious Disease Mental Health Musculoskeletal Neurology Obesity Ophthalmology Patient Safety Pregnancy Renal Respiratory Substance Abuse Not Applicable (NA) 23

24 Buying Value Tool Search Function (Cont.) Measure Type Cost/Resource Use Outcome Patient Experience Process Structure Population All Ages Adult (18+ Years) Pediatric (0-18 Years) Older Adult (65+ Years) Not Applicable Data Source Claims Claims/Clinical Data Claims/Social Service Data Clinical Data Independent Review Medicare Complaints Tracking Module (CTM) Other Plan Reporting Provider Attestation Survey 24

25 Buying Value Tool Search Function (Cont.) 25

26 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Learn About Vermont s Experience 6. Respond to Questions and Share Resources

27 Demonstration of the Measure Selection Tool 27

28 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Learn About Vermont s Experience 6. Respond to Questions and Share Resources

29 Experience with the Buying Value Measure Selection Tool Pat Jones, Health Care Project Director Green Mountain Care Board, Vermont 29

30 Goals for Today s Presentation 1. Understand the History of Buying Value 2. Review Resources to Help Create Aligned Measure Sets 3. Explain Updates to the New Buying Value Measure Selection Tool (BVMST) 4. Demonstrate the BVMST 5. Listen to Experiences with the BVMST 6. Respond to Questions and Share Resources

31 Questions?????? 31

32 Resources Webinar materials will be ed to participants and made available on the SHVS website Buying Value Bailit Health-authored brief titled Considerations for State Development of Performance Measure Sets 32